N582 Vignettes 1–4 Bundled Assignment
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VIGNETTE 1: Community-Acquired Pneumonia With Sepsis
A 72-year-old man presents to the emergency department with fever, productive cough, weakness,
and confusion for 2 days. His history includes COPD, hypertension, and type 2 diabetes. Vital signs: T
39.1°C (102.4°F), HR 118/min, RR 30/min, BP 86/52 mmHg, SpO₂ 88% on room air. He is lethargic but
arousable. Crackles are heard in the right lower lung field. Chest radiograph shows a right lower-lobe
infiltrate. Laboratory values: WBC 18,900/mm³, lactate 4.6 mmol/L, creatinine 2.0 mg/dL (baseline
1.0 mg/dL), glucose 268 mg/dL.
Questions 1–25
1. Which finding is most concerning for septic shock?
A. Temperature of 39.1°C
B. Heart rate of 118/min
C. Lactate level of 4.6 mmol/L with hypotension
D. WBC count of 18,900/mm³
Answer: C. Lactate level of 4.6 mmol/L with hypotension
Rationale: Elevated lactate indicates tissue hypoperfusion. Hypotension plus elevated lactate in
suspected infection is highly concerning for septic shock.
2. What is the priority initial nursing intervention?
A. Administer oral acetaminophen
B. Obtain a sputum culture after antibiotics are started
C. Apply supplemental oxygen and assess airway/breathing
D. Encourage oral fluid intake
Answer: C. Apply supplemental oxygen and assess airway/breathing
,Rationale: Airway and breathing are immediate priorities. The patient is hypoxemic with an oxygen
saturation of 88%.
3. Which oxygen saturation goal is most appropriate initially for this patient with COPD and acute
pneumonia?
A. 80%–84%
B. 88%–92%
C. 94%–100% regardless of symptoms
D. 100% at all times
Answer: B. 88%–92%
Rationale: Patients with COPD may be managed with a target SpO₂ of approximately 88%–92% to
correct hypoxemia while reducing risk of excessive oxygen administration.
4. Which action should occur before administration of broad-spectrum IV antibiotics if it does not
delay treatment?
A. Obtain blood cultures
B. Administer a bronchodilator
C. Insert a urinary catheter
D. Obtain a fasting glucose level
Answer: A. Obtain blood cultures
Rationale: Blood cultures should be collected before antibiotics when possible, but antibiotic
treatment should not be delayed in a patient with suspected sepsis.
5. Which fluid is generally recommended for initial volume resuscitation in septic shock?
A. 0.45% sodium chloride
B. Lactated Ringer’s or normal saline
C. Dextrose 5% in water
D. 3% hypertonic saline
Answer: B. Lactated Ringer’s or normal saline
,Rationale: Isotonic crystalloids are recommended for initial fluid resuscitation in sepsis and septic
shock.
6. Which assessment best indicates improved tissue perfusion after resuscitation?
A. Temperature decreases from 39.1°C to 38.7°C
B. WBC count decreases by 1,000/mm³
C. Urine output increases to at least 0.5 mL/kg/hr
D. Cough becomes less productive
Answer: C. Urine output increases to at least 0.5 mL/kg/hr
Rationale: Adequate urine output is an important marker of renal perfusion and response to
resuscitation.
7. The patient remains hypotensive after adequate IV fluid resuscitation. Which medication is most
appropriate next?
A. Norepinephrine infusion
B. Furosemide IV
C. Metoprolol IV
D. Nitroglycerin infusion
Answer: A. Norepinephrine infusion
Rationale: Norepinephrine is the preferred first-line vasopressor for septic shock when hypotension
persists after fluid resuscitation.
8. What is the target mean arterial pressure (MAP) generally used in initial septic shock
management?
A. At least 50 mmHg
B. At least 65 mmHg
C. At least 85 mmHg
D. At least 100 mmHg
Answer: B. At least 65 mmHg
, Rationale: A MAP of 65 mmHg or greater is commonly targeted initially to support organ perfusion in
adults with septic shock.
9. Which laboratory result most strongly supports acute kidney injury in this patient?
A. Glucose 268 mg/dL
B. Creatinine increased from 1.0 to 2.0 mg/dL
C. WBC 18,900/mm³
D. Lactate 4.6 mmol/L
Answer: B. Creatinine increased from 1.0 to 2.0 mg/dL
Rationale: A significant increase in serum creatinine from baseline suggests acute kidney injury, likely
from sepsis-related hypoperfusion.
10. Which medication should be used cautiously because it may worsen renal perfusion in this
patient?
A. Acetaminophen
B. Albuterol
C. Ibuprofen
D. Ondansetron
Answer: C. Ibuprofen
Rationale: NSAIDs can reduce renal blood flow and may worsen acute kidney injury, especially in
hypotensive or volume-depleted patients.
11. The patient becomes increasingly somnolent. Which finding would most strongly suggest
worsening respiratory failure?
A. Respiratory rate decreases from 30/min to 12/min
B. SpO₂ increases to 92% on oxygen
C. PaCO₂ rises significantly on arterial blood gas
D. Temperature decreases to 38.0°C
Answer: C. PaCO₂ rises significantly on arterial blood gas
Exam with correct answers and
rationale graded a+ new!!
VIGNETTE 1: Community-Acquired Pneumonia With Sepsis
A 72-year-old man presents to the emergency department with fever, productive cough, weakness,
and confusion for 2 days. His history includes COPD, hypertension, and type 2 diabetes. Vital signs: T
39.1°C (102.4°F), HR 118/min, RR 30/min, BP 86/52 mmHg, SpO₂ 88% on room air. He is lethargic but
arousable. Crackles are heard in the right lower lung field. Chest radiograph shows a right lower-lobe
infiltrate. Laboratory values: WBC 18,900/mm³, lactate 4.6 mmol/L, creatinine 2.0 mg/dL (baseline
1.0 mg/dL), glucose 268 mg/dL.
Questions 1–25
1. Which finding is most concerning for septic shock?
A. Temperature of 39.1°C
B. Heart rate of 118/min
C. Lactate level of 4.6 mmol/L with hypotension
D. WBC count of 18,900/mm³
Answer: C. Lactate level of 4.6 mmol/L with hypotension
Rationale: Elevated lactate indicates tissue hypoperfusion. Hypotension plus elevated lactate in
suspected infection is highly concerning for septic shock.
2. What is the priority initial nursing intervention?
A. Administer oral acetaminophen
B. Obtain a sputum culture after antibiotics are started
C. Apply supplemental oxygen and assess airway/breathing
D. Encourage oral fluid intake
Answer: C. Apply supplemental oxygen and assess airway/breathing
,Rationale: Airway and breathing are immediate priorities. The patient is hypoxemic with an oxygen
saturation of 88%.
3. Which oxygen saturation goal is most appropriate initially for this patient with COPD and acute
pneumonia?
A. 80%–84%
B. 88%–92%
C. 94%–100% regardless of symptoms
D. 100% at all times
Answer: B. 88%–92%
Rationale: Patients with COPD may be managed with a target SpO₂ of approximately 88%–92% to
correct hypoxemia while reducing risk of excessive oxygen administration.
4. Which action should occur before administration of broad-spectrum IV antibiotics if it does not
delay treatment?
A. Obtain blood cultures
B. Administer a bronchodilator
C. Insert a urinary catheter
D. Obtain a fasting glucose level
Answer: A. Obtain blood cultures
Rationale: Blood cultures should be collected before antibiotics when possible, but antibiotic
treatment should not be delayed in a patient with suspected sepsis.
5. Which fluid is generally recommended for initial volume resuscitation in septic shock?
A. 0.45% sodium chloride
B. Lactated Ringer’s or normal saline
C. Dextrose 5% in water
D. 3% hypertonic saline
Answer: B. Lactated Ringer’s or normal saline
,Rationale: Isotonic crystalloids are recommended for initial fluid resuscitation in sepsis and septic
shock.
6. Which assessment best indicates improved tissue perfusion after resuscitation?
A. Temperature decreases from 39.1°C to 38.7°C
B. WBC count decreases by 1,000/mm³
C. Urine output increases to at least 0.5 mL/kg/hr
D. Cough becomes less productive
Answer: C. Urine output increases to at least 0.5 mL/kg/hr
Rationale: Adequate urine output is an important marker of renal perfusion and response to
resuscitation.
7. The patient remains hypotensive after adequate IV fluid resuscitation. Which medication is most
appropriate next?
A. Norepinephrine infusion
B. Furosemide IV
C. Metoprolol IV
D. Nitroglycerin infusion
Answer: A. Norepinephrine infusion
Rationale: Norepinephrine is the preferred first-line vasopressor for septic shock when hypotension
persists after fluid resuscitation.
8. What is the target mean arterial pressure (MAP) generally used in initial septic shock
management?
A. At least 50 mmHg
B. At least 65 mmHg
C. At least 85 mmHg
D. At least 100 mmHg
Answer: B. At least 65 mmHg
, Rationale: A MAP of 65 mmHg or greater is commonly targeted initially to support organ perfusion in
adults with septic shock.
9. Which laboratory result most strongly supports acute kidney injury in this patient?
A. Glucose 268 mg/dL
B. Creatinine increased from 1.0 to 2.0 mg/dL
C. WBC 18,900/mm³
D. Lactate 4.6 mmol/L
Answer: B. Creatinine increased from 1.0 to 2.0 mg/dL
Rationale: A significant increase in serum creatinine from baseline suggests acute kidney injury, likely
from sepsis-related hypoperfusion.
10. Which medication should be used cautiously because it may worsen renal perfusion in this
patient?
A. Acetaminophen
B. Albuterol
C. Ibuprofen
D. Ondansetron
Answer: C. Ibuprofen
Rationale: NSAIDs can reduce renal blood flow and may worsen acute kidney injury, especially in
hypotensive or volume-depleted patients.
11. The patient becomes increasingly somnolent. Which finding would most strongly suggest
worsening respiratory failure?
A. Respiratory rate decreases from 30/min to 12/min
B. SpO₂ increases to 92% on oxygen
C. PaCO₂ rises significantly on arterial blood gas
D. Temperature decreases to 38.0°C
Answer: C. PaCO₂ rises significantly on arterial blood gas
